Provider Demographics
NPI:1104017201
Name:CARBON-MONROE-PIKE MH/MR PROGRAM
Entity Type:Organization
Organization Name:CARBON-MONROE-PIKE MH/MR PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODOROU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-420-1900
Mailing Address - Street 1:724 PHILLIPS ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2242
Mailing Address - Country:US
Mailing Address - Phone:570-420-1900
Mailing Address - Fax:570-517-5422
Practice Address - Street 1:730A PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2239
Practice Address - Country:US
Practice Address - Phone:570-420-1900
Practice Address - Fax:570-517-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management